Expectation of Unpleasant Events in Anxiety Disorders

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Fear and anxiety are normal responses to a threat. However, anxiety is considered abnormal when the response to the threat is excessive or inappropriate. This study will examine changes in the body and brain that occur during unpleasant learning experiences in healthy volunteers with high, moderate, and low levels of anxiety.

A high degree of generalized anxiety is a component of many anxiety disorders and is regarded as a marker of vulnerability for these disorders. People with anxiety disorders and individuals with high degrees of anxiety have inappropriate expectations of unpleasant events. This study will investigate the development of expecting unpleasant events in healthy volunteers with varying degrees of anxiety using aversive conditioning models. A later phase of the study will enroll participants with anxiety disorders and compare their responses to those of healthy volunteers.

Patients who meet criteria for an anxiety disorder, and healthy volunteers who have no history of psychiatric or major medical illness will be enrolled in this study. Volunteers will come to the NIH Clinical Center three times for outpatient testing....

Condition or disease

Anxiety Disorders

Detailed Description:

High-generalized anxiety is a concomitant of many anxiety disorders and is often regarded as a vulnerability marker for these disorders. One characteristic of patients with anxiety disorders and high trait-anxious individuals is inappropriate expectancies of aversive events. The overall aim of the present protocol is to investigate mechanisms that may promote the development of these aversive expectancies using expectancy-based, associative-learning models.

During aversive conditioning in which a phasic explicit-cue (e.g., a light) is repeatedly associated with an aversive unconditioned-stimulus (e.g., a shock), the organism develops fear to the explicit cue as well as to the environmental context in which the experiment took place. We have obtained preliminary evidence suggesting that contextual fear represents aspects of aversive states that are central to anxiety disorders. In this protocol, we seek further evidence for the relevance of contextual fear to mood anxiety disorders.

One important determinant of contextual fear in both humans and animals is predictability: contextual fear increases when aversive events (e.g., electric shock) are unpredictable, as opposed to when they are predictable. The present protocol will examine the role of predictability of aversive states and of conditioning on threat appraisal in individuals with mood and anxiety disorders..

A second aim is to examine the interaction between experimentally-induced anxiety and cognitive processes, more specifically working memory, in mood and anxiety disorders.

A final aim is to investigate whether the relationship between heightened emotional reactivity to threat and impaired cognitive functions under threat in patients with anxiety disorders is susceptible to treatment with cognitive behavioral therapy (CBT).

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Ages Eligible for Study:

18 Years to 50 Years (Adult)

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Yes

Criteria

INCLUSION CRITERIA:

Inclusion criteria for both patients and healthy controls

All subjects must be able to give written informed consent prior to participation in this study.

PATIENTS ONLY: May be taking the mood stabilizers, Depakote or Lithium Carbonate.

Speaks English or Spanish fluently (subjects with Major Depressive Disorder, healthy volunteers)

EXCLUSION CRITERIA:

Exclusion criteria for healthy subjects

Female subjects who are currently pregnant

Subjects who meet DSM-IV criteria for current alcohol or substance abuse

Subjects with a history of alcohol or substance dependence within 6 months prior to screening

Current Axis I psychiatric disorders as identified with the Structured Clinical Interview for DSM-IV-TR axis disorders, non-patient edition (SCID-np). Past history of any psychotic disorder or bipolar disorder.

I-Q<80

Medical illnesses (such as diabetes or hypertension) or neurological illnesses (such as carpal tunnel syndrome for shocks to be delivered on affected arm; organic brain impairment; seizure disorder) likely to interfere with the study.

Subjects who are on a medication that may interfere with the study.

Employee of NIMH or an immediate family member who is a NIMH employee.

Exclusion criteria for patients

Patients who would be unable to comply with study procedures or assessments;

Female patients who are currently pregnant;

Patients who meet DSM-IV criteria for current alcohol or substance abuse

Subjects with a history of alcohol or substance dependence within 6 months prior to screening;

Patients who are on a medication (other than mood stabilizers lithium carbonate or Depakote) that may interfere with the study

Patients will be excluded if they have a current or past history of, delirium, dementia, amnestic disorder, any of the pervasive developmental disorders; or cognitive impairment.

Current Axis I psychiatric disorders as identified with the Structured Clinical Interview for DSM-IV-TR axis disorders, non-patient edition (SCID) with the exception of the mood and anxiety disorders. Past history of any psychotic disorder or bipolar disorder..

IQ<80

Not speaking English (except patients with MDD who may be Spanish-speaking); Non-English speaking patients with anxiety disorders will not be recruited because the anxiety-related instruments of interest are not validated in Spanish. Subjects with an anxiety disorder who do not speak English fluently will be excluded because two of our primary anxiety-related instruments of interest (PSWQ and POMS) are not validated in languages other than English.

Employee of NIMH or an immediate family member who is an NIMH employee.

Additional exclusion criteria for the exercise substudy:

History of exercise intolerance

History of heart disease

History of pulmonary disease, other than controlled, non-excercise-induced asthma

History of uncontrolled diabetes

Resting heart rate > 90 BPM

Resting systolic pressure> 140mmHG or diastolic blood pressure>90mmHg

Peripheral condition making completion of the exercise impossible, such as severe osteoarthritis or chronic pain